MEDICARE: DAOUD'S PROKINETIC SPORTS CHIROPRACTIC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	33093	CA

General Provider Information

NPI Number	:	1093129637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAOUD'S PROKINETIC SPORTS CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	73140 HIGHWAY 111
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3927
Country	:	US
Telephone Number	:	760-834-8725
Fax Number	:

Provider Business Practice Location Address
First Line	:	73140 HIGHWAY 111
Second Line	:	STE 8
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3927
Country	:	US
Telephone Number	:	760-834-8725
Fax Number	:	760-834-8725

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. MAURICE DAOUD
Credential	:	DC
Telephone Number	:	760-834-8725

Provider Enumeration Date	:	06/11/2014
Last Update Date	:	09/10/2015

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